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What to D.O.

What to D.O.

Ready for COVID-19 — and Every Chart in the Rack

Pescatore, Richard DO

Emergency Medicine News: June 2020 - Volume 42 - Issue 6 - p 6
doi: 10.1097/01.EEM.0000669312.92664.c5
    coronavirus, COVID-19

    The name of my column is What to D.O., a perhaps not-particularly-witty combination of my osteopathic credentials and a goal of advocating for new and evidence-informed additions to our therapeutic armaments. Having written for EMN for nearly a decade, I've been fortunate enough to have the broad exposure of emergency medicine to drive discussion and content. I use on-shift experience, conversations with friends and colleagues, and even social media to identify areas where we as emergency physicians can explore different ways to grow our profession and scope while refining our routine practice.

    As I sit down to write this month's column, though, the intricacy and excitement of traditional emergency medicine seem almost an extravagance, a frivolous distraction from the pressures of the moment. As I type these words in early April, the warming weather and sunny skies belie the devastation within our hospitals.

    I've just returned from a stretch of shifts in North Jersey and New York City. I intubated more people in a few days than I can recall doing over the past several months, labored over treatment options and therapeutic maneuvers cloaked in a fog of uncertainty, and declared the final resting time for many souls.

    I could write about the litany of therapies and theories that emerge every day. I could soliloquize about what we know or think about hydroxychloroquine. I could discuss the interpolated evidence of azithromycin or the extrapolated applications for remdesivir, Kaletra, sildenafil, Actemra, or convalescent plasma. I could also fall down a rabbit hole of pathophysiologic theories of functional hemoglobinopathies, of altitude sickness, of hypercoagulability; I could pen a lofty dismissal of all but conservative supportive care.

    All, though, would be an antiquity by the time of this piece's publication in early June. With any luck, by the time these words find their place, we'll have begun to emerge from the shadows within which we all now find ourselves. We will know much more than we pretend to at the moment, and the early days of summer will bring a slow return to normalcy.

    What, Then, to Do?

    One of the many important lessons learned during the COVID-19 pandemic has been the importance of our daily tasks. Sometimes we may begrudge the ceaseless tides that crowd our emergency departments during normal times, but these are the very patients for whom we are needed so frequently. It was a sobering and untimely realization for some of us as volumes plummeted and—at least in some shops across the country—staffing narrowed and hours were cut in response. As the world returns to normal and ED volumes resume their previous patterns, it will become more important than ever that we approach these problems with an unassailable and evidence-based excellence.

    As emergency physicians, we know what it means to put the past where it belongs. In normal times, it's an afterthought to move from a cardiac arrest in Room 3 to a sore throat in Room 4. We routinely deliver devastating news or face unthinkable horrors before simply moving on to the next task. We let these moments guide us and learn from their lessons, but the survival of the department—and of our profession—depends on our ability to pick up the next chart in the rack and move forward through the never-ending maw.

    As a specialty, emergency medicine reacted quickly and cohesively to COVID-19, bolstering our place as the simultaneous front line and safety net of the health care system. Our capacity to adapt will shine all the more brightly by resuming the critical roles we played before SARS-CoV-2 arrived.

    I don't know what will have happened by the time you read this. I don't know if we will have discovered any game-changing therapies or if we'll have flattened the curve and muted the pandemic's effects throughout the nation. I'm not sure how many more emergency physicians will fall as victims of COVID-19 or how many of our families or loved ones will no longer be with us.

    I don't know if I'll survive.

    What I do know is that all across the country right now, emergency physicians are responding to their communities' calls. EPs from every corner of the map are standing vigil under fluorescent lights, and thousands have already fought the paradigm-defying virus with the same calm and skill they bring to every shift. COVID-19 will bring unprecedented challenges that will meet with unprecedented ability. We will move forward by doing what we do best, by grabbing the next chart in the rack, standing ready to help the next person in need, and providing excellent and evidence-based care for every complaint that we encounter.

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    Dr. Pescatoreis an emergency physician in New Jersey and the host with Ali Raja, MD, of the podcast EMN Live, which focuses on hot topics in emergency medicine: Follow him on Twitter@Rick_Pescatore, and read his past columns at

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